A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes, mouth, throat, and tongue [if scarlet fever is the cause: maculopapular (fine-spotted) exanthema (begins on neck and extends to extremities (hands and feet are left out); after exanthema disappears, skin peels); whitish tongue (early phase of infection); strawberry or raspberry tongue (late phase of infection); perioral pallor (pale skin around mouth); [due toDifferential diagnoses: erythema infectiosum (ringworm); Morbilli (measles); Rubella (rubella); Impetigo contagiosa – inflammation of the skin triggered by streptococci of serogroup A; erysipelas (erysipelas); phlegmon – diffuse inflammation of the connective tissue, which spreads further under the skin].
- Auscultation (listening) of the heart.
- Examination of the lungs
- Auscultation (listening) of the lungs
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Palpation (palpation) of the abdomen (abdomen), renal bearings (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial ports?, Kidney bearing palpation?) [appendicitis (appendicitis); peritonitis (peritonitis); acute glomerulonephritis – inflammatory kidney disease that occurs on both sides of the glomeruli (renal corpuscles) and can lead to permanent kidney damage (possible sequela)]
- Inspection (viewing).
- Ophthalmologic examination – Ulcus serpens corneae (“creeping ulcer“; ulcer (ulcer) of the cornea (cornea of the eye) caused by penetration of the pathogen into the superficial cornea and a rapid “creeping” spread is possible).
- ENT medical examination – if otitis media (inflammation of the middle ear) is suspected.
Square brackets [ ] indicate possible pathological (pathological) physical findings.
